Training enough nurses for health reform and aging baby boomers

The nursing shortage was a recognized problem before reform; what will happen now?

Officials recently broke ground here on a major school expansion that when completed next spring will include, among other things, four simulated hospital rooms with robotic patients to help train nurses, surgical technicians and other health professionals.

Neosho County Community College already graduates more nurses than any other of the state's 25 community or public technical colleges, which together are the largest source of nurses entering the Kansas workforce.

The college, which schools nurses in Ottawa, Independence and at its home campus in Chanute, has graduated more than 200 practical and registered nurses in the past six months.

It, like other Kansas nursing schools the past few years, has been pushing to train more students in anticipation of the major shortages coming as baby boomer nurses retire in the same wave of generational aging that is expected to press the nation's health care system to new limits.

The graying of America

“With the graying of America, we're going to have to be very vigilant to put out as many graduates as will be needed. When I got here in 2003, our program was half this size. We have essentially doubled it,” said Neosho County Community College Vice President Brian Inbody.

Federal health reform, the most significant provisions of which begin in 2014, also is expected to create new demand for nurses and other health professionals even as the major demographic forces stir. The new law is expected to extend health insurance to at least 130,000 additional Kansans and millions more Americans.

“Health reform may change some things for some (medical) providers,” said Kathleen Harr, vice president and dean of Baker University's School of Nursing, which is on the campus of Stormont-Vail Healthcare in Topeka. “We may need more nurse practitioners, for example, and we're working to produce more people with that qualification. But certainly the demand for nurses who can work in the hospital at the bedside will only increase as the boomer generation moves along. I see it more as a demographic issue.

courtesy Baker University

In this spring 2008 photo, Baker University nursing student Dana Hogan of Topeka practices critical-care techniques on a computer-controlled human patient simulator at Stormont-Vail HealthCare in Topeka. Hogan graduated in spring 2009. Baker University, like most Kansas schools training nurses, has increased in the past few years the number of students it graduates.

“The boomer nurses (the largest cohort in the field) and other health care providers are going to be retiring in probably the next five 10, 15, 20 years,” Harr said. “So trying to produce enough nurses to replace them...it's really been a challenge for us.”

Harr said the Baker U. nursing program also has been growing. Clinical training capacity is better than good at the school because of its close relationship with Stormont-Vail. The university also has been able to find enough nursing faculty, Harr said, which isn't the case everywhere.

“We have gradually over the last five to six years increased our enrollment,” she said. “We've gone from 120 students to right now expecting 175 for the fall.”

Still not enough

That coming expansion at Neosho County Community College celebrated with the June 2 groundbreaking still won't accommodate all who would like to enroll in its nursing programs. (Recently there were 200 applications for 45 openings, school officials said.)

According to Kansas Board of Nursing statistics, all but one of the 13 public or private schools that train registered nurses in Kansas increased their graduation numbers between 2004 and 2008, some dramatically so. Sixteen of the 22 schools that train practical nurses also reported larger graduating classes in 2008 than in 2004.

But that growth isn't putting a major dent in the shortages Kansas and the nation are expected to face in the next few years.

The federal Bureau of Labor Statistics in December projected that 581,500 RN positions would be created nationwide through 2018.

Many of those slots, presumably, will be filled thanks to greater output by the nation's nursing schools.

But according to an article in the July/August 2009 issue of Health Affairs, the RN shortage is forecast to reach 260,000 by 2025. The article was authored by Dr. Peter Buerhaus of Vanderbilt University, considered one of the nation's top scholars on nurse workforce issues.

The federal Health Resources and Services Administration reports Kansas is short 1,000 registered nurses this year and by 2015 likely will have 3,100 fewer than needed.

Labor market observers and Kansas school officials said the recession has made it easier for Kansas hospitals and other employers to hire or keep nurses the last two years. Still, unlike graduates of most other disciplines, new nurses struggling to find jobs are considered rare in the state.

And about a third of the nurses trained at Baker U. don't even have to leave campus when they enter the jobforce. They go straight to work for Stormont-Vail, Harr said, the school's partner hospital where the new nurses received their clinical training.

State higher education officials say there is no way Kansas colleges and universities can train enough nurses to meet the expected, simultaneous demands generated by an aging population, a wave of retiring nurses and health reform, despite the apparent success of an initiative approved by the 2006 Legislature.

That initiative, which began in fiscal year 2007, created a one-time, $2 million fund for improving clinical training equipment and required some matching funds from the schools.

“We encouraged the schools to invest in high-fidelity simulators,” said Don Richards, a workforce specialist at the Kansas Board of Regents, “because that would enable the students to attain training at an enhanced level while still in school with the expectation that advanced training would help offset some of the time they would need in front of actual patients.”

Finding enough clinical settings for students to learn in has been one of the bottlenecks limiting the number that can be trained. That and a shortage of nursing faculty.

With that in mind, lawmakers also approved a second grant fund aimed at increasing the number of nurse teachers.

Funding more faculty

The fund for faculty salaries and supplies in its first year was $1.2 million, which was matched dollar-for-dollar by the schools. That was increased to $1.8 million the following year and then to $1.9 million the next. That annual allocation has been determined by the Regents and the sum for fiscal 2011, which begins July 1, hadn't been decided yet when this article went to press.

The faculty allocation was to be renewable for each of 10 years, contingent on the condition of state coffers and the dollars available for higher education programs.

Also approved was a grant fund to help nurses with a bachelor's degree enter graduate programs. The grants, which require 50 cents-on the-dollar match from the nurses entering the program, covers 70 percent of tuition fees and books. In return the graduates must agree to work as a nursing educator once they graduate.

Richards said the goal of the three grants was to increase the number of nursing student berths by 250. It has worked well enough that the schools have actually added more than 500, he said.

But that still won't be enough to meet the expected needs. And Richards said there is probably no way Kansas nursing schools will be able to meet demand.

“Our schools are producing about as many nurses as they can produce,” Richards said. “You have to have qualified faculty and the clinical access. It's not quite like having a history course or math course where you simply increase class size to accommodate more students. It's a little hard to increase the capacity of the (nursing) schools and I think all the schools are pretty much running at capacity.”